What is the role of fluid resuscitation in the treatment of heat stroke?

Updated: Nov 06, 2018
  • Author: Robert S Helman, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

Recommendations on the administration of intravenous fluids for circulatory support differ among patient populations and depend on the presence of hypovolemia, preexisting medical conditions, and preexisting cardiovascular disease.

While patients with heat stroke invariably are volume depleted, cooling alone may improve hypotension and cardiac function by allowing blood to redistribute centrally. Aggressive fluid resuscitation generally is not recommended because it may lead to pulmonary edema. Cor pulmonale also is a common finding in patients with heat stroke.

When pulse rate, blood pressure, and urine output do not provide adequate hemodynamic information, fluid administration should be guided by more invasive hemodynamic parameters, such as central venous pressure (CVP), pulmonary capillary wedge pressure, systemic vascular resistance index (SVRI), and cardiac index (CI) measurements. Patients who exhibit a hyperdynamic state (ie, high CI, low SVRI) generally respond to cooling and do not require large amounts of intravenous crystalloid infusions.

Hypotensive patients who exhibit a hypodynamic response (ie, high CVP, low CI) historically have been treated with low-dose isoproterenol; however, its arrhythmogenicity has raised questions about its continued use. Dobutamine, which is less arrhythmogenic than isoproterenol and more cardioselective, may be the inotrope of choice in these patients. Alpha-adrenergic drugs generally are contraindicated because they cause vasoconstriction and may interfere with heat loss.


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